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@ARTICLE{Luft:128092,
      author       = {T. Luft and A. Benner$^*$ and S. Jodele and C. E. Dandoy
                      and R. Storb and T. Gooley and B. M. Sandmaier and N.
                      Becker$^*$ and A. Radujkovic and P. Dreger and O. Penack},
      title        = {{EASIX} in patients with acute graft-versus-host disease: a
                      retrospective cohort analysis.},
      journal      = {The lancet / Haematology},
      volume       = {4},
      number       = {9},
      issn         = {2352-3026},
      address      = {London [u.a.]},
      publisher    = {Elsevier},
      reportid     = {DKFZ-2017-04114},
      pages        = {e414 - e423},
      year         = {2017},
      abstract     = {Endothelial dysfunction links thrombotic microangiopathy to
                      steroid-refractory graft-versus-host disease (GVHD) after
                      allogeneic stem-cell transplantation. We aimed to assess if
                      the simple formula-lactate dehydrogenase
                      (U/L) × creatinine (mg/dL)/thrombocytes (10(9) cells
                      per L)-termed the Endothelial Activation and Stress Index
                      (EASIX), might be valuable for the prediction of death in
                      patients with acute GVHD after allogeneic stem-cell
                      transplantation.For this retrospective analysis, we analysed
                      a training cohort (in Germany) and three validation cohorts
                      (in Germany and the USA) of patients with acute GVHD who had
                      received consecutive allogeneic stem-cell transplantation.
                      The primary endpoint was prediction of overall survival when
                      measured at acute GVHD onset (EASIX-GVHD). We validated the
                      prognostic strength of EASIX-GVHD for overall survival and
                      non-relapse mortality in the three independent cohorts by
                      calculating the prediction error (integrated Brier score),
                      and concordance index.In the total cohort of patients with
                      acute GVHD (n=311), EASIX-GVHD predicted overall survival in
                      univariable and multivariable models (univariate analysis,
                      hazard ratio [HR] for a one-fold increase 1·16, $95\%$ CI
                      1·12-1·20, p=0·0004). However, in the subpopulation of
                      patients with myeloablative conditioning (n=72), EASIX-GVHD
                      did not predict overall survival, which is probably
                      attributable to thrombocytopenia at GVHD onset
                      (73 × 10(9) cells per L [IQR 29·75-180·00] for
                      myeloablative conditioning vs 160 × 10(9) cells per L
                      [90·0-250·5] for reduced-intensity conditioning;
                      p<0·0001). In patients who received reduced-intensity
                      conditioning (n=239), EASIX-GVHD was a strong predictor of
                      overall survival (HR for a two-fold change of 1·23, $95\%$
                      CI 1·13-1·34; p<0·0001) and non-relapse mortality
                      (cause-specific HR for a two-fold change of 1·24,
                      1·12-1·38; p<0·0001). Model validation for prediction of
                      overall survival and non-relapse mortality by EASIX-GVHD was
                      successful in two independent cohorts of adult patients with
                      reduced-intensity conditioning (n=141, n=173) and in a
                      cohort with mainly paediatric patients (n=89).In patients
                      with reduced-intensity conditioning, EASIX-GVHD is a
                      powerful predictor of survival after GVHD. EASIX-GVHD could
                      be the future basis for development of risk-adapted GVHD
                      treatment strategies.There was no external funding source
                      for this study.},
      cin          = {C060},
      ddc          = {610},
      cid          = {I:(DE-He78)C060-20160331},
      pnm          = {313 - Cancer risk factors and prevention (POF3-313)},
      pid          = {G:(DE-HGF)POF3-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:28733186},
      doi          = {10.1016/S2352-3026(17)30108-4},
      url          = {https://inrepo02.dkfz.de/record/128092},
}